OBJECTIVE-Offspring of mothers with type 1 diabetes (OT1DM) demonstrate increased fat deposition, hyperinsulinemia, and hyperleptinemia in utero. We examined the influence of maternal diabetes on cord lipids at birth and relationship to body composition, cord insulin, leptin, and other hormonal measures.
RESEARCH DESIGN AND METHODS-We performed an observational study measuring fetal, HDL, and LDL cholesterol; triglycerides; and nonesterified fatty acids (NEFAs) in a total of 139 OT1DM and 48 control subjects at birth and assessed cross-sectional relationships with birth weight, fetal insulin, leptin, adiponectin, and IGF-1.
RESULTS-Concentrations of total cholesterol (male OT1DM[mean Ϯ SD] 1.49 Ϯ 0.45 mmol/l and male control subjects 1.74 Ϯ 0.33 mmol/l; P Ͻ 0.001), HDL cholesterol (0.53 Ϯ 0.21 and 0.74 Ϯ 0.19 mmol/l, respectively; P Ͻ 0.001), and NEFA (median 0.17 [interquartile range 2.30Ϫ2.95] and 0.21 [0.18 -0.36], respectively; P Ͻ 0.001) were significantly lower in male OT1DM, with no significant differences in female subjects. Differences in male subjects were independent of mode of delivery. Cord lipids were unrelated to birth weight in OT1DM and did not show consistent relationships with fetal insulin. Unexpectedly, IGF-1 was a strong correlate of HDL cholesterol in control subjects (r ϭ 0.40, P ϭ 0.002) and OT1DM (r ϭ 0.32, P Ͻ 0.001) but a negative correlate of triglycerides in control subjects (r ϭ Ϫ0.48, P Ͻ 0.001) and OT1DM (r ϭ Ϫ0.21, P ϭ 0.004), with these relationships present in both sexes. In OT1DM, leptin was also independently correlated (negatively, P Ͻ 0.001) with HDL cholesterol in male and female subjects.CONCLUSIONS-Maternal diabetes is associated with significant alterations in lipid levels in male fetuses. IGF-1, leptin, and male sex rather than insulin may be the major determinants of HDL cholesterol and triglycerides in utero. Diabetes 56:2705-2709, 2007 T here is increasing interest in how the intrauterine environment might influence cardiovascular and metabolic disease throughout life. In nondiabetic pregnancies, lower birth weight (1,2) (and smaller fetal abdominal circumference [3]) is associated with higher cord triglycerides and less consistently with lower HDL cholesterol (1,4) in addition to the welldescribed associations with increased risk of cardiovascular disease in adult life (5). Notably, much is still not known about the control or function of circulating fetal lipoproteins in utero. While free fatty acids cross the placenta, lipoproteins do not, and transfer of cholesterol is extremely limited (6). Oversupply of lipids, particularly nonesterified fatty acids (NEFAs), to the fetus have been proposed as a factor in promoting fetal adiposity (7,8). Maternal diabetes during pregnancy is associated with characteristic overgrowth of the fetus as well as marked hyperinsulinemia and hyperleptinemia, which is easily detectable in cord samples at birth (9). Offspring of mothers with type 2 diabetes are subject to in utero programming effects with increased risk of type 2 diabet...